Question: What to do next? TSH and Thyroid peroxidase antibody level are normal.

[SuperMeerkat81]

Sorry for the long post.

Shortly after birth of my 1st child (February 2004), i had enlarged Thyroids and I was given levothyroxin. The Thyroids went back to normal size after aspiration and so I only took Levo for a short time.

Recently, over the past year, I have had the following symptoms: tiredness, weight gain and not being able to shift weight despite eating healthily and exercising, aches, feeling cold, dry skin, lifeless and thinning hair, brain fog, and low mood. I also have a trapped ulnar nerve so I get pins and needles on my left hand and painful elbow. I went to the GP and lab results showed:

02Oct2012

TSH level: 1.60 mu/L (0.35-5.5)

Total WBC: 5.9 x10e9/L (4.0-11.0)

Red blood cell count: 4.55 x10e12/L (3.8-5.3)

Haemoglobin concentration: 13.8 g/dL (11.5-16.0)

Haematocrit: 0.409 1/1 (0.35-0.46)

Mean cell volume: 89.8 fL (80.0-100.0)

mean cell haemoglobin level: 30.4 pg (27.0-32.0)

RBC distribution width: 13.9 (11-16)

Platelet count: 231 x10e9/L (150.0-400.0)

Mean platelet volume: 7.6 fL

Neutrophil count: 3.22 x10e9/L (2.0-8.0)

Lymphocyte count: 2.13 x10e9/L (1.0-4.5)

Monocyte count: 0.33 x10e9/L (0.1-0.8)

Eosinophil count: 0.18 x10e9/L (0.0-0.4)

Basophil count: 0.02 x10e9/L (0.0-0.3)

Serum Sodium: 136 mmol/L (135-145)

Serum Potassium: 3.6 mmol/L (3.4-5.0)

Serum creatinine level: 67 umol/L (35.0-125.0)

GFR: >60

Albumin: 44 g/L (30-51)

Total bilirubin: 11 umol/L (0.0-17.0)

Alkaline phosphatase: 71 u/L (30-135)

ALT/SGPT: 22 u/L (0-50)

Cholesterol level: 5.1 mmol/L

Triglyceride level: 0.8 mmol/L

HDL: 2.13 mmol/L

LDL: 2.67 mmol/L

Cholesterol/HDL ratio: 2.3 1/1

Plasma fasting Glucose level: 4.3 mmol/L (3.5-6.0)

The doctor said I am fine as my TSH is within reference range. I said I feel so low and have all these aches, could not shift my excess weight and other symptoms, surely something is wrong with me. The GP prescribed me antidepressants! I didn't take them as this will only address one symptom and disregarding the rest. I went back for more tests. Thyroid peroxidase antibody level was normal however my corrected calcium level was below normal so I had to do another test. See below:

11Dec2012

Thyroid peroxidase antibody level <5.0 iu/mL (0-100)

Bone profile

Albumin level: 41.0 g/L (30-51)

Calcium level: 2.12 mmol

Corrected serum calcium level 2.06 mmol/L (2.1-2.5)

Inorganic phosphate: 1.14 mmol/L (0.8-1.4)

Alkaline phosphatase: 76.0 iu/L (30-135)

The following week, calcium level has gone back to within reference range (borderline - i also ate a lot of cheese the night before which may have affected the result... just a guess) however my Vitamin D is very low and so I was prescribed to take Vit D supplement. See below:

Repeat test on 19Dec2012

Albumin level: 41.0 g/L (30-51)

Calcium level: 2.16 mmol

Corrected serum calcium level 2.10 mmol/L (2.1-2.5)

Inorganic phosphate: 1.06 mmol/L (0.8-1.4)

Alkaline phosphatase: 71.0 iu/L (30-135)

Serum 25-hydroxy vitamin D3 level: 29.7 nmol/L

Vitamin D2 level: <5.0 nmol/L

Ranges below relate to total 25-OH vitamin D (D2=D3)

Below 25nmol/L: Vitamin D deficient

25-50 nmol/L: Sub-optimal

I don't know what to do now. I have just started a new job (desk based computer work, similar to my previous jobs for the last 6 years) but I feel so tired all the time and I find I cannot sleep well at night. Brain fog is not good as well as I have to remember a lot of facts in my job. Are there any other tests that I could undergo? or maybe my symptoms are just down to low calcium and vit d... It is so hard to talk to these GP's and it doesn't help that I am unable to see the same GP consistently. The last GP I saw suggested my fatigue was due to being a mother!

Any advice greatly appreciated.

[shaws Administrator]

Is your doctor supplementing you with vitamin D3 as you are extremely low? You should have a vitamin B12 blood test too as it is very important for those of us with an autoimmune condition.

If you can afford it I would suggest a private sympathetic doctor. Some can tell at a glance whether you are hypo or not and prescribe on clinical symptoms

thyroiduk.org.uk/tuk/diagno...

Others will comment on your other tests.

[Hidden]

Wow - it's great you've got your blood test results, brilliant. but the wood from the trees...

TSH 1.6 'normal' - maybe - depends what your 'normal was

Thyroid peroxidase antibody level <5.0 OK not autoimmune?

Serum 25-hydroxy vitamin D3 level: 29.7 nmol/L - definitely deficient

Calcium level: 2.16 mmol - is that low? no range. I don't know.

irons? - folate & ferratin? not just HB

B12? - isn't that part of the Haematocrit test?

Serum Sodium: 136 mmol/L (135-145) ??

You stopped Levo after an aspiration? - as far as I'm aware my FNA (fine needle aspiration) was a test, not a treatment. Levo (T4) is the treatment (replacement thyroid hormone).

Well done for avoiding antidepressants when you thought it wasn't depression.

Your symptoms, and enlarged Thyroid certainly indicate Hypothyroidism - however if it's Hashimotos levels go up and down (however the presence of TPO antibodies usually indicates this).

I suggest (and it's only a suggestion as we're not docs here) you get FT4 and FT3 tested too

and Vit D3 sorted and ask for specific folate, ferratin. B12 tests too (tend to be low if Hypo). supplementing Vit D CAN improve aches & tingling for starters (from my own experience).

Jane x

[SuperMeerkat81]

Hi Shaws, thanks for responding. The doctor prescribed me 1000ug of vitamin D a day. As for the private doctor, I will have a look into it and do some budgeting.

Hi Jane, yes, for some reason I stopped taking Levo, I don't remember why... there was no definite diagnosis when my thyroid got enlarged and it went back to normal size so i just stopped it. I am waiting for vit D supplement's effect to kick in soon it is quite tricky to keep the arm straight all the time for fear of more tingling and numbness.

As for the lab tests, I was only able to get the first round of lab tests when a particular sympathetic gp (sadly, he is only a locum so I never get to see him again) agreed to the tests, and this gave me the confidence to ask for further tests from the GP's I've seen since.

[SuperMeerkat81]

PS for the serum calcium, a reference range was not provided.

[merissa]

Have you checked tg antibodies? Thyroglobulin can be raised in hashimotos, even if other parameters are normal. X